Search

Introduction For the entire evolution of our species, we have been exposed to a wide range of infectious agents – parasites, bacteria, and viruses – resulting in a range of diseases. The dental and skeletal evidence for some of these diseases, mostly chronic, is well documented (Aufderheide & Rodriguez-Martin, 1998; Ortner, 2003; Roberts & Manchester, 2005). Current bioarchaeological inquiry emphasizes biocultural perspectives of disease in relation to social, cultural, and environmental contexts and risks for infection, impacts on population, and implications for pathogen – host evolution (Armelagos & Van Gerven, 2003; Buikstra, 2010; Buikstra & Cook, 1980; Larsen & Walker, 2010). This growing record of health in past populations and especially the emphasis on origins and evolution of infectious disease in the biocultural context provides a powerful approach for understanding health determinants and outcomes in the world we live in today. Infection by a pathogen does not always result in disease. The progression from infection to disease depends on agent pathogenicity, transmission route from agent to host, and the strength and nature of the response of the host (Brown et al., 2011; Inhorn & Brown, 1990; Smith & Moss, 1994). Many acute infectious diseases or epidemics result in death of the infected individual soon after microbial attack. These infectious diseases leave no skeletal record, clouding the full picture of disease and its relationship to mortality in past populations. A number of chronic infectious diseases affect osseous tissues in patterned ways. Despite the interpretive drawbacks and sometimes lack of specificity, the study of bone lesions documenting disease provides important perspectives on health in earlier societies and the impacts of particular living circumstances on the human condition.

Advanced lesions of the face, nasopharynx, and oropharynx have played an important role in the medical and social history of Hansen's disease. Renaissance artists included detailed portrayals of these lesions in some of their paintings, a testimony not only to their artistic skill and powers of observation but also to the common presence of these patients in European cities and towns of the period. The disease is now understood as a broad immunologic spectrum of host responses to Mycobacterium leprae, with a variety of clinical and pathologic manifestations in nerve, soft tissues, and bone. This review incorporates the findings of 2 extraordinary studies (one from Europe and the other from Japan) of pharyngeal and facial lesions. In the 1950s, studies of skeletal remains from the churchyard of a Danish leprosarium revealed a triad of maxillofacial lesions unique to leprosy and designated facies leprosa. In pre-World War II Japan, before effective treatment had been discovered, a prominent otorhinolaryngologist studying oropharyngeal and nasopharyngeal lesions prepared watercolor illustrations of the natural progression of untreated Hansen's disease. As a result of effective antimicrobial therapy, such advanced lesions are now rarely seen, but the presenting signs and symptoms of leprosy still occasionally arise in the nasal and oral mucosa. The nasopharynx and oropharynx may be important early sites of inoculation and infection by M leprae, and they require additional emphasis in worldwide efforts toward early diagnosis and treatment of Hansen's disease.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae that affects almost 500,000 people worldwide^1^. The timing of first infection, geographic origin, and pattern of transmission of the disease are unknown^1-3^. Comparative genomics research has recently suggested M. leprae evolved in East Africa or South Asia before spreading to Europe and the rest of the World^4-5^. The earliest accepted textual evidence indicates that leprosy existed in India by at least 600 B.C. and was known in Europe by 400 B.C.^6-7^. The earliest skeletal evidence was dated 300-200 B.C. in Egypt^8^ and Thailand^9^. Here, we report the presence of lepromatous leprosy in skeletal remains from Balathal, a Chalcolithic site (2300-1550 B.C.) in India^10-11^. A middle aged adult male skeleton demonstrates manifestations of facies leprosa and rhinomaxillary syndrome, degenerative joint disease, infectious involvement of the tibia (periostitis), and injury to the peripheral skeleton, often the result of skin anaesthesia. Paleopathological analysis indicates that lepromatous leprosy was present in India by 1800 B.C., a result which supports some translations of the Atharva Veda that reference leprosy and its treatment in hymns composed before the first millennium B.C.^12^. The presence of leprosy in Chalcolithic India suggests M. leprae may have been transmitted during the second or third millennium B.C., at a time when there was substantial interaction between South Asia, West Asia, and Northeastern Africa^13^. This evidence should be impetus to look for additional skeletal and molecular evidence of leprosy in human remains from this time period in India and Africa to confirm the origin of the disease.

A male skeleton of 7th century date from the Anglo-Saxon cemetery at Eccles, Kent, is described. Certain skeletal changes associated with leprosy are manifest. The disease is discussed in its palaeopathological context and this case in relation to the few other cases of the disease hitherto diagnosed in Great Britain.